Application Form

Please complete this form, print from your browser, sign, date and post with your cheque to:-

Bradford Civic Society, Ground Floor Offices, Sunbridge House, 80 Kirkgate, Bradford, BD1 1TH

Name:

House No/Street:

Address 2:

Town/City:

County:

Postcode:

Telephone:

Email Address:

Annual Subscription:
(Tick One Box)

£10 Individual:
£15 Couple:
£20 Family (2 + 2):
£3 Unwaged/Senior Citizens:
£50 Corporate:

Gift Aid Declaration:

I would like Bradford Civic Society to reclaim tax I have paid on this and any future memberships subscriptions and donations until I notify you otherwise.

Signature:

_____________________________________

Date:

_________________

Please make all cheques payable to Bradford Civic Society

Registered Charity No: 1115384